Systems and methods for adjusting remote center distances in medical procedures

ABSTRACT

Systems and methods for adjusting remote center distances in medical procedures are provided. In one aspect, a robotic medical system includes a first robotic arm including a first instrument driver, wherein the first instrument driver is configured to manipulate a first tool that passes through a first cannula, and a second robotic arm including a second instrument driver, wherein the second instrument driver is configured to manipulate a second tool that passes through a second cannula. The first tool is configured to rotate about a first remote center of motion and the second tool is configured to rotate about a second remote center of motion. A first remote center distance between the first robotic arm and the first remote center of motion is different from a second remote center distance between the second robotic arm and the second remote center of motion.

CROSS-REFERENCE TO RELATED APPLICATION(S)

This application claims the benefit of U.S. Provisional Application No.62/882,427, filed Aug. 2, 2019, which is hereby incorporated byreference in its entirety.

TECHNICAL FIELD

The systems and methods disclosed herein are directed to surgicalrobotics, and more particularly to adjusting a medical device remotecenter.

BACKGROUND

Medical procedures, such as laparoscopy, may involve accessing andvisualizing an internal region of a patient. In a laparoscopicprocedure, a medical instrument can be inserted into the internal regionthrough a laparoscopic cannula.

In certain procedures, a robotically-enabled medical system may be usedto control the insertion and/or manipulation of the medical instrumentand end effector. The robotically-enabled medical system may enforce aremote center of motion around which the medical instrument and cannulacan be rotated.

SUMMARY

The systems, methods and devices of this disclosure each have severalinnovative aspects, no single one of which is solely responsible for thedesirable attributes disclosed herein.

In one aspect, there is provided a robotic medical system, comprising: afirst robotic arm including a first instrument driver and a plurality ofrobotic joints, wherein the first instrument driver is configured tomanipulate a first tool that passes through a first cannula coupled tothe first robotic arm; and a second robotic arm including a secondinstrument driver and a plurality of robotic joints, wherein the secondinstrument driver is configured to manipulate a second tool that passesthrough a second cannula coupled to the second robotic arm, wherein thefirst tool is configured to rotate about a first remote center ofmotion; wherein the second tool is configured to rotate about a secondremote center of motion; and wherein a first remote center distancebetween the first robotic arm and the first remote center of motion isdifferent from a second remote center distance between the secondrobotic arm and the second remote center of motion.

In another aspect, there is provided a surgical method, comprising:maintaining a first remote center distance between an interface betweena first robotic arm and a first cannula coupled to the first roboticarm, and a first remote center of motion, wherein the first robotic armis configured to insert a first medical tool through the first cannula,wherein the first robotic arm is coupled to the first cannula; andmaintaining a second remote center distance between an interface betweena second robotic arm and a second cannula coupled to the second roboticarm, wherein the second robotic arm is configured to insert a secondmedical tool through the second cannula, wherein the second robotic armis coupled to the second cannula; wherein the first remote centerdistance is different from the second remote center distance.

In yet another aspect, there is provided a robotic medical system,comprising: a robotic arm including an instrument drive mechanism, therobotic arm associated with a cannula; a processor; and at least onecomputer-readable memory in communication with the processor and havingstored thereon computer-executable instructions to cause the processorto: adjust a remote center distance between the robotic arm and a remotecenter of motion.

In still yet another aspect, there is provided a surgical method,comprising: providing a robotic arm comprising a drive mechanism,wherein the robotic arm is associated with a cannula and a remote centerof motion, the robotic arm and the remote center of motion having aremote center distance there between; and adjusting the remote centerdistance between the robotic arm and the remote center of motion.

In another aspect, there is provided a robotic medical system,comprising: a robotic arm including an instrument driver and a pluralityof robotic joints, wherein the instrument driver is configured tomanipulate a tool that passes through a cannula coupled to the roboticarm; and a processor; and at least one computer-readable memory incommunication with the processor and having stored thereoncomputer-executable instructions to cause the processor to: control therobotic arm to move the tool while maintaining a remote center ofmotion, and dynamically adjust a position of the cannula with respect toa body wall of a patient.

BRIEF DESCRIPTION OF THE DRAWINGS

The disclosed aspects will hereinafter be described in conjunction withthe appended drawings, provided to illustrate and not to limit thedisclosed aspects, wherein like designations denote like elements.

FIG. 1 illustrates an embodiment of a cart-based robotic system arrangedfor diagnostic and/or therapeutic bronchoscopy.

FIG. 2 depicts further aspects of the robotic system of FIG. 1.

FIG. 3 illustrates an embodiment of the robotic system of FIG. 1arranged for ureteroscopy.

FIG. 4 illustrates an embodiment of the robotic system of FIG. 1arranged for a vascular procedure.

FIG. 5 illustrates an embodiment of a table-based robotic systemarranged for a bronchoscopic procedure.

FIG. 6 provides an alternative view of the robotic system of FIG. 5.

FIG. 7 illustrates an example system configured to stow robotic arm(s).

FIG. 8 illustrates an embodiment of a table-based robotic systemconfigured for a ureteroscopic procedure.

FIG. 9 illustrates an embodiment of a table-based robotic systemconfigured for a laparoscopic procedure.

FIG. 10 illustrates an embodiment of the table-based robotic system ofFIGS. 5-9 with pitch or tilt adjustment.

FIG. 11 provides a detailed illustration of the interface between thetable and the column of the table-based robotic system of FIGS. 5-10.

FIG. 12 illustrates an alternative embodiment of a table-based roboticsystem.

FIG. 13 illustrates an end view of the table-based robotic system ofFIG. 12.

FIG. 14 illustrates an end view of a table-based robotic system withrobotic arms attached thereto.

FIG. 15 illustrates an exemplary instrument driver.

FIG. 16 illustrates an exemplary medical instrument with a pairedinstrument driver.

FIG. 17 illustrates an alternative design for an instrument driver andinstrument where the axes of the drive units are parallel to the axis ofthe elongated shaft of the instrument.

FIG. 18 illustrates an instrument having an instrument-based insertionarchitecture.

FIG. 19 illustrates an exemplary controller.

FIG. 20 depicts a block diagram illustrating a localization system thatestimates a location of one or more elements of the robotic systems ofFIGS. 1-10, such as the location of the instrument of FIGS. 16-18, inaccordance to an example embodiment.

FIG. 21 illustrates exemplary movement of an ADM while maintaining aremote center of motion in accordance with aspects of this disclosure.

FIG. 22 illustrates an ADM prior to docking of the ADM to a cannula inaccordance with aspects of this disclosure.

FIGS. 23A and 23B illustrate example remote center distances which canbe used to determine minimum port spacing in accordance with aspects ofthis disclosure.

FIG. 24 illustrates a robotic medical system with a plurality of roboticarms in position to perform a portion of a partial nephrectomy surgicalprocedure in accordance with aspects of this disclosure.

FIG. 25 is a flowchart illustrating an example method operable by arobotic system, or component(s) thereof, for maintaining two differentremove center distances in accordance with aspects of this disclosure.

FIG. 26 is a flowchart illustrating an example method operable by arobotic system, or component(s) thereof, for adjusting a remote centerdistance in accordance with aspects of this disclosure.

FIGS. 27A-27E illustrate an example of using remote center distanceadjustment to increase a maximum distance that a medial tool can beinserted into a patient in accordance with aspects of this disclosure.

FIGS. 28A and 28B illustrate an example mechanical-based technique forsetting remote center distances in accordance with aspects of thisdisclosure.

FIG. 29 illustrates an example surgical procedure using cannulas ofdifferent lengths in accordance with aspects of this disclosure.

FIGS. 30A and 30B illustrate examples of an ADM being latched andunlatched from a corresponding cannula in accordance with aspects ofthis disclosure.

DETAILED DESCRIPTION 1. Overview

Aspects of the present disclosure may be integrated into arobotically-enabled medical system capable of performing a variety ofmedical procedures, including both minimally invasive, such aslaparoscopy, and non-invasive, such as endoscopy, procedures. Amongendoscopic procedures, the system may be capable of performingbronchoscopy, ureteroscopy, gastroscopy, etc.

In addition to performing the breadth of procedures, the system mayprovide additional benefits, such as enhanced imaging and guidance toassist the physician. Additionally, the system may provide the physicianwith the ability to perform the procedure from an ergonomic positionwithout the need for awkward arm motions and positions. Still further,the system may provide the physician with the ability to perform theprocedure with improved ease of use such that one or more of theinstruments of the system can be controlled by a single user.

Various embodiments will be described below in conjunction with thedrawings for purposes of illustration. It should be appreciated thatmany other implementations of the disclosed concepts are possible, andvarious advantages can be achieved with the disclosed implementations.Headings are included herein for reference and to aid in locatingvarious sections. These headings are not intended to limit the scope ofthe concepts described with respect thereto. Such concepts may haveapplicability throughout the entire specification.

A. Robotic System—Cart.

The robotically-enabled medical system may be configured in a variety ofways depending on the particular procedure. FIG. 1 illustrates anembodiment of a cart-based robotically-enabled system 10 arranged for adiagnostic and/or therapeutic bronchoscopy. During a bronchoscopy, thesystem 10 may comprise a cart 11 having one or more robotic arms 12 todeliver a medical instrument, such as a steerable endoscope 13, whichmay be a procedure-specific bronchoscope for bronchoscopy, to a naturalorifice access point (i.e., the mouth of the patient positioned on atable in the present example) to deliver diagnostic and/or therapeutictools. As shown, the cart 11 may be positioned proximate to thepatient's upper torso in order to provide access to the access point.Similarly, the robotic arms 12 may be actuated to position thebronchoscope relative to the access point. The arrangement in FIG. 1 mayalso be utilized when performing a gastro-intestinal (GI) procedure witha gastroscope, a specialized endoscope for GI procedures. FIG. 2 depictsan example embodiment of the cart in greater detail.

With continued reference to FIG. 1, once the cart 11 is properlypositioned, the robotic arms 12 may insert the steerable endoscope 13into the patient robotically, manually, or a combination thereof. Asshown, the steerable endoscope 13 may comprise at least two telescopingparts, such as an inner leader portion and an outer sheath portion, eachportion coupled to a separate instrument driver from the set ofinstrument drivers 28, each instrument driver coupled to the distal endof an individual robotic arm. This linear arrangement of the instrumentdrivers 28, which facilitates coaxially aligning the leader portion withthe sheath portion, creates a “virtual rail” 29 that may be repositionedin space by manipulating the one or more robotic arms 12 into differentangles and/or positions. The virtual rails described herein are depictedin the Figures using dashed lines, and accordingly the dashed lines donot depict any physical structure of the system. Translation of theinstrument drivers 28 along the virtual rail 29 telescopes the innerleader portion relative to the outer sheath portion or advances orretracts the endoscope 13 from the patient. The angle of the virtualrail 29 may be adjusted, translated, and pivoted based on clinicalapplication or physician preference. For example, in bronchoscopy, theangle and position of the virtual rail 29 as shown represents acompromise between providing physician access to the endoscope 13 whileminimizing friction that results from bending the endoscope 13 into thepatient's mouth.

The endoscope 13 may be directed down the patient's trachea and lungsafter insertion using precise commands from the robotic system untilreaching the target destination or operative site. In order to enhancenavigation through the patient's lung network and/or reach the desiredtarget, the endoscope 13 may be manipulated to telescopically extend theinner leader portion from the outer sheath portion to obtain enhancedarticulation and greater bend radius. The use of separate instrumentdrivers 28 also allows the leader portion and sheath portion to bedriven independently of each other.

For example, the endoscope 13 may be directed to deliver a biopsy needleto a target, such as, for example, a lesion or nodule within the lungsof a patient. The needle may be deployed down a working channel thatruns the length of the endoscope to obtain a tissue sample to beanalyzed by a pathologist. Depending on the pathology results,additional tools may be deployed down the working channel of theendoscope for additional biopsies. After identifying a nodule to bemalignant, the endoscope 13 may endoscopically deliver tools to resectthe potentially cancerous tissue. In some instances, diagnostic andtherapeutic treatments can be delivered in separate procedures. In thosecircumstances, the endoscope 13 may also be used to deliver a fiducialto “mark” the location of the target nodule as well. In other instances,diagnostic and therapeutic treatments may be delivered during the sameprocedure.

The system 10 may also include a movable tower 30, which may beconnected via support cables to the cart 11 to provide support forcontrols, electronics, fluidics, optics, sensors, and/or power to thecart 11. Placing such functionality in the tower 30 allows for a smallerform factor cart 11 that may be more easily adjusted and/or repositionedby an operating physician and his/her staff. Additionally, the divisionof functionality between the cart/table and the support tower 30 reducesoperating room clutter and facilitates improving clinical workflow.While the cart 11 may be positioned close to the patient, the tower 30may be stowed in a remote location to stay out of the way during aprocedure.

In support of the robotic systems described above, the tower 30 mayinclude component(s) of a computer-based control system that storescomputer program instructions, for example, within a non-transitorycomputer-readable storage medium such as a persistent magnetic storagedrive, solid state drive, etc. The execution of those instructions,whether the execution occurs in the tower 30 or the cart 11, may controlthe entire system or sub-system(s) thereof. For example, when executedby a processor of the computer system, the instructions may cause thecomponents of the robotics system to actuate the relevant carriages andarm mounts, actuate the robotics arms, and control the medicalinstruments. For example, in response to receiving the control signal,the motors in the joints of the robotics arms may position the arms intoa certain posture.

The tower 30 may also include a pump, flow meter, valve control, and/orfluid access in order to provide controlled irrigation and aspirationcapabilities to the system that may be deployed through the endoscope13. These components may also be controlled using the computer system ofthe tower 30. In some embodiments, irrigation and aspirationcapabilities may be delivered directly to the endoscope 13 throughseparate cable(s).

The tower 30 may include a voltage and surge protector designed toprovide filtered and protected electrical power to the cart 11, therebyavoiding placement of a power transformer and other auxiliary powercomponents in the cart 11, resulting in a smaller, more moveable cart11.

The tower 30 may also include support equipment for the sensors deployedthroughout the robotic system 10. For example, the tower 30 may includeoptoelectronics equipment for detecting, receiving, and processing datareceived from the optical sensors or cameras throughout the roboticsystem 10. In combination with the control system, such optoelectronicsequipment may be used to generate real-time images for display in anynumber of consoles deployed throughout the system, including in thetower 30. Similarly, the tower 30 may also include an electronicsubsystem for receiving and processing signals received from deployedelectromagnetic (EM) sensors. The tower 30 may also be used to house andposition an EM field generator for detection by EM sensors in or on themedical instrument.

The tower 30 may also include a console 31 in addition to other consolesavailable in the rest of the system, e.g., console mounted on top of thecart. The console 31 may include a user interface and a display screen,such as a touchscreen, for the physician operator. Consoles in thesystem 10 are generally designed to provide both robotic controls aswell as preoperative and real-time information of the procedure, such asnavigational and localization information of the endoscope 13. When theconsole 31 is not the only console available to the physician, it may beused by a second operator, such as a nurse, to monitor the health orvitals of the patient and the operation of the system 10, as well as toprovide procedure-specific data, such as navigational and localizationinformation. In other embodiments, the console 30 is housed in a bodythat is separate from the tower 30.

The tower 30 may be coupled to the cart 11 and endoscope 13 through oneor more cables or connections (not shown). In some embodiments, thesupport functionality from the tower 30 may be provided through a singlecable to the cart 11, simplifying and de-cluttering the operating room.In other embodiments, specific functionality may be coupled in separatecabling and connections. For example, while power may be providedthrough a single power cable to the cart 11, the support for controls,optics, fluidics, and/or navigation may be provided through a separatecable.

FIG. 2 provides a detailed illustration of an embodiment of the cart 11from the cart-based robotically-enabled system shown in FIG. 1. The cart11 generally includes an elongated support structure 14 (often referredto as a “column”), a cart base 15, and a console 16 at the top of thecolumn 14. The column 14 may include one or more carriages, such as acarriage 17 (alternatively “arm support”) for supporting the deploymentof one or more robotic arms 12 (three shown in FIG. 2). The carriage 17may include individually configurable arm mounts that rotate along aperpendicular axis to adjust the base of the robotic arms 12 for betterpositioning relative to the patient. The carriage 17 also includes acarriage interface 19 that allows the carriage 17 to verticallytranslate along the column 14.

The carriage interface 19 is connected to the column 14 through slots,such as slot 20, that are positioned on opposite sides of the column 14to guide the vertical translation of the carriage 17. The slot 20contains a vertical translation interface to position and hold thecarriage 17 at various vertical heights relative to the cart base 15.Vertical translation of the carriage 17 allows the cart 11 to adjust thereach of the robotic arms 12 to meet a variety of table heights, patientsizes, and physician preferences. Similarly, the individuallyconfigurable arm mounts on the carriage 17 allow the robotic arm base 21of the robotic arms 12 to be angled in a variety of configurations.

In some embodiments, the slot 20 may be supplemented with slot coversthat are flush and parallel to the slot surface to prevent dirt andfluid ingress into the internal chambers of the column 14 and thevertical translation interface as the carriage 17 vertically translates.The slot covers may be deployed through pairs of spring spoolspositioned near the vertical top and bottom of the slot 20. The coversare coiled within the spools until deployed to extend and retract fromtheir coiled state as the carriage 17 vertically translates up and down.The spring-loading of the spools provides force to retract the coverinto a spool when the carriage 17 translates towards the spool, whilealso maintaining a tight seal when the carriage 17 translates away fromthe spool. The covers may be connected to the carriage 17 using, forexample, brackets in the carriage interface 19 to ensure properextension and retraction of the cover as the carriage 17 translates.

The column 14 may internally comprise mechanisms, such as gears andmotors, that are designed to use a vertically aligned lead screw totranslate the carriage 17 in a mechanized fashion in response to controlsignals generated in response to user inputs, e.g., inputs from theconsole 16.

The robotic arms 12 may generally comprise robotic arm bases 21 and endeffectors 22, separated by a series of linkages 23 that are connected bya series of joints 24, each joint comprising an independent actuator,each actuator comprising an independently controllable motor. Eachindependently controllable joint represents an independentdegree-of-freedom (DoF) available to the robotic arm 12. Each of therobotic arms 12 may have seven joints, and thus provide seven degrees offreedom. A multitude of joints result in a multitude of degrees offreedom, allowing for “redundant” degrees of freedom. Having redundantdegrees of freedom allows the robotic arms 12 to position theirrespective end effectors 22 at a specific position, orientation, andtrajectory in space using different linkage positions and joint angles.This allows for the system to position and direct a medical instrumentfrom a desired point in space while allowing the physician to move thearm joints into a clinically advantageous position away from the patientto create greater access, while avoiding arm collisions.

The cart base 15 balances the weight of the column 14, carriage 17, androbotic arms 12 over the floor. Accordingly, the cart base 15 housesheavier components, such as electronics, motors, power supply, as wellas components that either enable movement and/or immobilize the cart 11.For example, the cart base 15 includes rollable wheel-shaped casters 25that allow for the cart 11 to easily move around the room prior to aprocedure. After reaching the appropriate position, the casters 25 maybe immobilized using wheel locks to hold the cart 11 in place during theprocedure.

Positioned at the vertical end of the column 14, the console 16 allowsfor both a user interface for receiving user input and a display screen(or a dual-purpose device such as, for example, a touchscreen 26) toprovide the physician user with both preoperative and intraoperativedata. Potential preoperative data on the touchscreen 26 may includepreoperative plans, navigation and mapping data derived frompreoperative computerized tomography (CT) scans, and/or notes frompreoperative patient interviews. Intraoperative data on display mayinclude optical information provided from the tool, sensor andcoordinate information from sensors, as well as vital patientstatistics, such as respiration, heart rate, and/or pulse. The console16 may be positioned and tilted to allow a physician to access theconsole 16 from the side of the column 14 opposite the carriage 17. Fromthis position, the physician may view the console 16, robotic arms 12,and patient while operating the console 16 from behind the cart 11. Asshown, the console 16 also includes a handle 27 to assist withmaneuvering and stabilizing the cart 11.

FIG. 3 illustrates an embodiment of a robotically-enabled system 10arranged for ureteroscopy. In a ureteroscopic procedure, the cart 11 maybe positioned to deliver a ureteroscope 32, a procedure-specificendoscope designed to traverse a patient's urethra and ureter, to thelower abdominal area of the patient. In a ureteroscopy, it may bedesirable for the ureteroscope 32 to be directly aligned with thepatient's urethra to reduce friction and forces on the sensitive anatomyin the area. As shown, the cart 11 may be aligned at the foot of thetable to allow the robotic arms 12 to position the ureteroscope 32 fordirect linear access to the patient's urethra. From the foot of thetable, the robotic arms 12 may insert the ureteroscope 32 along thevirtual rail 33 directly into the patient's lower abdomen through theurethra.

After insertion into the urethra, using similar control techniques as inbronchoscopy, the ureteroscope 32 may be navigated into the bladder,ureters, and/or kidneys for diagnostic and/or therapeutic applications.For example, the ureteroscope 32 may be directed into the ureter andkidneys to break up kidney stone build up using a laser or ultrasoniclithotripsy device deployed down the working channel of the ureteroscope32. After lithotripsy is complete, the resulting stone fragments may beremoved using baskets deployed down the ureteroscope 32.

FIG. 4 illustrates an embodiment of a robotically-enabled system 10similarly arranged for a vascular procedure. In a vascular procedure,the system 10 may be configured such that the cart 11 may deliver amedical instrument 34, such as a steerable catheter, to an access pointin the femoral artery in the patient's leg. The femoral artery presentsboth a larger diameter for navigation as well as a relatively lesscircuitous and tortuous path to the patient's heart, which simplifiesnavigation. As in a ureteroscopic procedure, the cart 11 may bepositioned towards the patient's legs and lower abdomen to allow therobotic arms 12 to provide a virtual rail 35 with direct linear accessto the femoral artery access point in the patient's thigh/hip region.After insertion into the artery, the medical instrument 34 may bedirected and inserted by translating the instrument drivers 28.Alternatively, the cart may be positioned around the patient's upperabdomen in order to reach alternative vascular access points, such as,for example, the carotid and brachial arteries near the shoulder andwrist.

B. Robotic System—Table.

Embodiments of the robotically-enabled medical system may alsoincorporate the patient's table. Incorporation of the table reduces theamount of capital equipment within the operating room by removing thecart, which allows greater access to the patient. FIG. 5 illustrates anembodiment of such a robotically-enabled system arranged for abronchoscopic procedure. System 36 includes a support structure orcolumn 37 for supporting platform 38 (shown as a “table” or “bed”) overthe floor. Much like in the cart-based systems, the end effectors of therobotic arms 39 of the system 36 comprise instrument drivers 42 that aredesigned to manipulate an elongated medical instrument, such as abronchoscope 40 in FIG. 5, through or along a virtual rail 41 formedfrom the linear alignment of the instrument drivers 42. In practice, aC-arm for providing fluoroscopic imaging may be positioned over thepatient's upper abdominal area by placing the emitter and detectoraround the table 38.

FIG. 6 provides an alternative view of the system 36 without the patientand medical instrument for discussion purposes. As shown, the column 37may include one or more carriages 43 shown as ring-shaped in the system36, from which the one or more robotic arms 39 may be based. Thecarriages 43 may translate along a vertical column interface 44 thatruns the length of the column 37 to provide different vantage pointsfrom which the robotic arms 39 may be positioned to reach the patient.The carriage(s) 43 may rotate around the column 37 using a mechanicalmotor positioned within the column 37 to allow the robotic arms 39 tohave access to multiples sides of the table 38, such as, for example,both sides of the patient. In embodiments with multiple carriages, thecarriages may be individually positioned on the column and may translateand/or rotate independently of the other carriages. While the carriages43 need not surround the column 37 or even be circular, the ring-shapeas shown facilitates rotation of the carriages 43 around the column 37while maintaining structural balance. Rotation and translation of thecarriages 43 allows the system 36 to align the medical instruments, suchas endoscopes and laparoscopes, into different access points on thepatient. In other embodiments (not shown), the system 36 can include apatient table or bed with adjustable arm supports in the form of bars orrails extending alongside it. One or more robotic arms 39 (e.g., via ashoulder with an elbow joint) can be attached to the adjustable armsupports, which can be vertically adjusted. By providing verticaladjustment, the robotic arms 39 are advantageously capable of beingstowed compactly beneath the patient table or bed, and subsequentlyraised during a procedure.

The robotic arms 39 may be mounted on the carriages 43 through a set ofarm mounts 45 comprising a series of joints that may individually rotateand/or telescopically extend to provide additional configurability tothe robotic arms 39. Additionally, the arm mounts 45 may be positionedon the carriages 43 such that, when the carriages 43 are appropriatelyrotated, the arm mounts 45 may be positioned on either the same side ofthe table 38 (as shown in FIG. 6), on opposite sides of the table 38 (asshown in FIG. 9), or on adjacent sides of the table 38 (not shown).

The column 37 structurally provides support for the table 38, and a pathfor vertical translation of the carriages 43. Internally, the column 37may be equipped with lead screws for guiding vertical translation of thecarriages, and motors to mechanize the translation of the carriages 43based the lead screws. The column 37 may also convey power and controlsignals to the carriages 43 and the robotic arms 39 mounted thereon.

The table base 46 serves a similar function as the cart base 15 in thecart 11 shown in FIG. 2, housing heavier components to balance thetable/bed 38, the column 37, the carriages 43, and the robotic arms 39.The table base 46 may also incorporate rigid casters to providestability during procedures. Deployed from the bottom of the table base46, the casters may extend in opposite directions on both sides of thebase 46 and retract when the system 36 needs to be moved.

With continued reference to FIG. 6, the system 36 may also include atower (not shown) that divides the functionality of the system 36between the table and the tower to reduce the form factor and bulk ofthe table. As in earlier disclosed embodiments, the tower may provide avariety of support functionalities to the table, such as processing,computing, and control capabilities, power, fluidics, and/or optical andsensor processing. The tower may also be movable to be positioned awayfrom the patient to improve physician access and de-clutter theoperating room. Additionally, placing components in the tower allows formore storage space in the table base 46 for potential stowage of therobotic arms 39. The tower may also include a master controller orconsole that provides both a user interface for user input, such askeyboard and/or pendant, as well as a display screen (or touchscreen)for preoperative and intraoperative information, such as real-timeimaging, navigation, and tracking information. In some embodiments, thetower may also contain holders for gas tanks to be used forinsufflation.

In some embodiments, a table base may stow and store the robotic armswhen not in use. FIG. 7 illustrates a system 47 that stows robotic armsin an embodiment of the table-based system. In the system 47, carriages48 may be vertically translated into base 49 to stow robotic arms 50,arm mounts 51, and the carriages 48 within the base 49. Base covers 52may be translated and retracted open to deploy the carriages 48, armmounts 51, and robotic arms 50 around column 53, and closed to stow toprotect them when not in use. The base covers 52 may be sealed with amembrane 54 along the edges of its opening to prevent dirt and fluidingress when closed.

FIG. 8 illustrates an embodiment of a robotically-enabled table-basedsystem configured for a ureteroscopic procedure. In a ureteroscopy, thetable 38 may include a swivel portion 55 for positioning a patientoff-angle from the column 37 and table base 46. The swivel portion 55may rotate or pivot around a pivot point (e.g., located below thepatient's head) in order to position the bottom portion of the swivelportion 55 away from the column 37. For example, the pivoting of theswivel portion 55 allows a C-arm (not shown) to be positioned over thepatient's lower abdomen without competing for space with the column (notshown) below table 38. By rotating the carriage 35 (not shown) aroundthe column 37, the robotic arms 39 may directly insert a ureteroscope 56along a virtual rail 57 into the patient's groin area to reach theurethra. In a ureteroscopy, stirrups 58 may also be fixed to the swivelportion 55 of the table 38 to support the position of the patient's legsduring the procedure and allow clear access to the patient's groin area.

In a laparoscopic procedure, through small incision(s) in the patient'sabdominal wall, minimally invasive instruments may be inserted into thepatient's anatomy. In some embodiments, the minimally invasiveinstruments comprise an elongated rigid member, such as a shaft, whichis used to access anatomy within the patient. After inflation of thepatient's abdominal cavity, the instruments may be directed to performsurgical or medical tasks, such as grasping, cutting, ablating,suturing, etc. In some embodiments, the instruments can comprise ascope, such as a laparoscope. FIG. 9 illustrates an embodiment of arobotically-enabled table-based system configured for a laparoscopicprocedure. As shown in FIG. 9, the carriages 43 of the system 36 may berotated and vertically adjusted to position pairs of the robotic arms 39on opposite sides of the table 38, such that instrument 59 may bepositioned using the arm mounts 45 to be passed through minimalincisions on both sides of the patient to reach his/her abdominalcavity.

To accommodate laparoscopic procedures, the robotically-enabled tablesystem may also tilt the platform to a desired angle. FIG. 10illustrates an embodiment of the robotically-enabled medical system withpitch or tilt adjustment. As shown in FIG. 10, the system 36 mayaccommodate tilt of the table 38 to position one portion of the table ata greater distance from the floor than the other. Additionally, the armmounts 45 may rotate to match the tilt such that the robotic arms 39maintain the same planar relationship with the table 38. To accommodatesteeper angles, the column 37 may also include telescoping portions 60that allow vertical extension of the column 37 to keep the table 38 fromtouching the floor or colliding with the table base 46.

FIG. 11 provides a detailed illustration of the interface between thetable 38 and the column 37. Pitch rotation mechanism 61 may beconfigured to alter the pitch angle of the table 38 relative to thecolumn 37 in multiple degrees of freedom. The pitch rotation mechanism61 may be enabled by the positioning of orthogonal axes 1, 2 at thecolumn-table interface, each axis actuated by a separate motor 3, 4responsive to an electrical pitch angle command. Rotation along onescrew 5 would enable tilt adjustments in one axis 1, while rotationalong the other screw 6 would enable tilt adjustments along the otheraxis 2. In some embodiments, a ball joint can be used to alter the pitchangle of the table 38 relative to the column 37 in multiple degrees offreedom.

For example, pitch adjustments are particularly useful when trying toposition the table in a Trendelenburg position, i.e., position thepatient's lower abdomen at a higher position from the floor than thepatient's upper abdomen, for lower abdominal surgery. The Trendelenburgposition causes the patient's internal organs to slide towards his/herupper abdomen through the force of gravity, clearing out the abdominalcavity for minimally invasive tools to enter and perform lower abdominalsurgical or medical procedures, such as laparoscopic prostatectomy.

FIGS. 12 and 13 illustrate isometric and end views of an alternativeembodiment of a table-based surgical robotics system 100. The surgicalrobotics system 100 includes one or more adjustable arm supports 105that can be configured to support one or more robotic arms (see, forexample, FIG. 14) relative to a table 101. In the illustratedembodiment, a single adjustable arm support 105 is shown, though anadditional arm support can be provided on an opposite side of the table101. The adjustable arm support 105 can be configured so that it canmove relative to the table 101 to adjust and/or vary the position of theadjustable arm support 105 and/or any robotic arms mounted theretorelative to the table 101. For example, the adjustable arm support 105may be adjusted one or more degrees of freedom relative to the table101. The adjustable arm support 105 provides high versatility to thesystem 100, including the ability to easily stow the one or moreadjustable arm supports 105 and any robotics arms attached theretobeneath the table 101. The adjustable arm support 105 can be elevatedfrom the stowed position to a position below an upper surface of thetable 101. In other embodiments, the adjustable arm support 105 can beelevated from the stowed position to a position above an upper surfaceof the table 101.

The adjustable arm support 105 can provide several degrees of freedom,including lift, lateral translation, tilt, etc. In the illustratedembodiment of FIGS. 12 and 13, the arm support 105 is configured withfour degrees of freedom, which are illustrated with arrows in FIG. 12. Afirst degree of freedom allows for adjustment of the adjustable armsupport 105 in the z-direction (“Z-lift”). For example, the adjustablearm support 105 can include a carriage 109 configured to move up or downalong or relative to a column 102 supporting the table 101. A seconddegree of freedom can allow the adjustable arm support 105 to tilt. Forexample, the adjustable arm support 105 can include a rotary joint,which can allow the adjustable arm support 105 to be aligned with thebed in a Trendelenburg position. A third degree of freedom can allow theadjustable arm support 105 to “pivot up,” which can be used to adjust adistance between a side of the table 101 and the adjustable arm support105. A fourth degree of freedom can permit translation of the adjustablearm support 105 along a longitudinal length of the table.

The surgical robotics system 100 in FIGS. 12 and 13 can comprise a tablesupported by a column 102 that is mounted to a base 103. The base 103and the column 102 support the table 101 relative to a support surface.A floor axis 131 and a support axis 133 are shown in FIG. 13.

The adjustable arm support 105 can be mounted to the column 102. Inother embodiments, the arm support 105 can be mounted to the table 101or base 103. The adjustable arm support 105 can include a carriage 109,a bar or rail connector 111 and a bar or rail 107. In some embodiments,one or more robotic arms mounted to the rail 107 can translate and moverelative to one another.

The carriage 109 can be attached to the column 102 by a first joint 113,which allows the carriage 109 to move relative to the column 102 (e.g.,such as up and down a first or vertical axis 123). The first joint 113can provide the first degree of freedom (“Z-lift”) to the adjustable armsupport 105. The adjustable arm support 105 can include a second joint115, which provides the second degree of freedom (tilt) for theadjustable arm support 105. The adjustable arm support 105 can include athird joint 117, which can provide the third degree of freedom (“pivotup”) for the adjustable arm support 105. An additional joint 119 (shownin FIG. 13) can be provided that mechanically constrains the third joint117 to maintain an orientation of the rail 107 as the rail connector 111is rotated about a third axis 127. The adjustable arm support 105 caninclude a fourth joint 121, which can provide a fourth degree of freedom(translation) for the adjustable arm support 105 along a fourth axis129.

FIG. 14 illustrates an end view of the surgical robotics system 140Awith two adjustable arm supports 105A, 105B mounted on opposite sides ofa table 101. A first robotic arm 142A is attached to the bar or rail107A of the first adjustable arm support 105B. The first robotic arm142A includes a base 144A attached to the rail 107A. The distal end ofthe first robotic arm 142A includes an instrument drive mechanism 146Athat can attach to one or more robotic medical instruments or tools.Similarly, the second robotic arm 142B includes a base 144B attached tothe rail 107B. The distal end of the second robotic arm 142B includes aninstrument drive mechanism 146B. The instrument drive mechanism 146B canbe configured to attach to one or more robotic medical instruments ortools.

In some embodiments, one or more of the robotic arms 142A, 142Bcomprises an arm with seven or more degrees of freedom. In someembodiments, one or more of the robotic arms 142A, 142B can includeeight degrees of freedom, including an insertion axis (1-degree offreedom including insertion), a wrist (3-degrees of freedom includingwrist pitch, yaw and roll), an elbow (1-degree of freedom includingelbow pitch), a shoulder (2-degrees of freedom including shoulder pitchand yaw), and base 144A, 144B (1-degree of freedom includingtranslation). In some embodiments, the insertion degree of freedom canbe provided by the robotic arm 142A, 142B, while in other embodiments,the instrument itself provides insertion via an instrument-basedinsertion architecture.

C. Instrument Driver & Interface.

The end effectors of the system's robotic arms may comprise (i) aninstrument driver (alternatively referred to as “instrument drivemechanism” or “instrument device manipulator”) that incorporateselectro-mechanical means for actuating the medical instrument and (ii) aremovable or detachable medical instrument, which may be devoid of anyelectro-mechanical components, such as motors. This dichotomy may bedriven by the need to sterilize medical instruments used in medicalprocedures, and the inability to adequately sterilize expensive capitalequipment due to their intricate mechanical assemblies and sensitiveelectronics. Accordingly, the medical instruments may be designed to bedetached, removed, and interchanged from the instrument driver (and thusthe system) for individual sterilization or disposal by the physician orthe physician's staff. In contrast, the instrument drivers need not bechanged or sterilized, and may be draped for protection.

FIG. 15 illustrates an example instrument driver. Positioned at thedistal end of a robotic arm, instrument driver 62 comprises one or moredrive units 63 arranged with parallel axes to provide controlled torqueto a medical instrument via drive shafts 64. Each drive unit 63comprises an individual drive shaft 64 for interacting with theinstrument, a gear head 65 for converting the motor shaft rotation to adesired torque, a motor 66 for generating the drive torque, an encoder67 to measure the speed of the motor shaft and provide feedback to thecontrol circuitry, and control circuitry 68 for receiving controlsignals and actuating the drive unit. Each drive unit 63 beingindependently controlled and motorized, the instrument driver 62 mayprovide multiple (e.g., four as shown in FIG. 15) independent driveoutputs to the medical instrument. In operation, the control circuitry68 would receive a control signal, transmit a motor signal to the motor66, compare the resulting motor speed as measured by the encoder 67 withthe desired speed, and modulate the motor signal to generate the desiredtorque.

For procedures that require a sterile environment, the robotic systemmay incorporate a drive interface, such as a sterile adapter connectedto a sterile drape, that sits between the instrument driver and themedical instrument. The chief purpose of the sterile adapter is totransfer angular motion from the drive shafts of the instrument driverto the drive inputs of the instrument while maintaining physicalseparation, and thus sterility, between the drive shafts and driveinputs. Accordingly, an example sterile adapter may comprise a series ofrotational inputs and outputs intended to be mated with the drive shaftsof the instrument driver and drive inputs on the instrument. Connectedto the sterile adapter, the sterile drape, comprised of a thin, flexiblematerial such as transparent or translucent plastic, is designed tocover the capital equipment, such as the instrument driver, robotic arm,and cart (in a cart-based system) or table (in a table-based system).Use of the drape would allow the capital equipment to be positionedproximate to the patient while still being located in an area notrequiring sterilization (i.e., non-sterile field). On the other side ofthe sterile drape, the medical instrument may interface with the patientin an area requiring sterilization (i.e., sterile field).

D. Medical Instrument.

FIG. 16 illustrates an example medical instrument with a pairedinstrument driver. Like other instruments designed for use with arobotic system, medical instrument 70 comprises an elongated shaft 71(or elongate body) and an instrument base 72. The instrument base 72,also referred to as an “instrument handle” due to its intended designfor manual interaction by the physician, may generally compriserotatable drive inputs 73, e.g., receptacles, pulleys or spools, thatare designed to be mated with drive outputs 74 that extend through adrive interface on instrument driver 75 at the distal end of robotic arm76. When physically connected, latched, and/or coupled, the mated driveinputs 73 of the instrument base 72 may share axes of rotation with thedrive outputs 74 in the instrument driver 75 to allow the transfer oftorque from the drive outputs 74 to the drive inputs 73. In someembodiments, the drive outputs 74 may comprise splines that are designedto mate with receptacles on the drive inputs 73.

The elongated shaft 71 is designed to be delivered through either ananatomical opening or lumen, e.g., as in endoscopy, or a minimallyinvasive incision, e.g., as in laparoscopy. The elongated shaft 71 maybe either flexible (e.g., having properties similar to an endoscope) orrigid (e.g., having properties similar to a laparoscope) or contain acustomized combination of both flexible and rigid portions. Whendesigned for laparoscopy, the distal end of a rigid elongated shaft maybe connected to an end effector extending from a jointed wrist formedfrom a clevis with at least one degree of freedom and a surgical tool ormedical instrument, such as, for example, a grasper or scissors, thatmay be actuated based on force from the tendons as the drive inputsrotate in response to torque received from the drive outputs 74 of theinstrument driver 75. When designed for endoscopy, the distal end of aflexible elongated shaft may include a steerable or controllable bendingsection that may be articulated and bent based on torque received fromthe drive outputs 74 of the instrument driver 75.

Torque from the instrument driver 75 is transmitted down the elongatedshaft 71 using tendons along the elongated shaft 71. These individualtendons, such as pull wires, may be individually anchored to individualdrive inputs 73 within the instrument handle 72. From the handle 72, thetendons are directed down one or more pull lumens along the elongatedshaft 71 and anchored at the distal portion of the elongated shaft 71,or in the wrist at the distal portion of the elongated shaft. During asurgical procedure, such as a laparoscopic, endoscopic or hybridprocedure, these tendons may be coupled to a distally mounted endeffector, such as a wrist, grasper, or scissor. Under such anarrangement, torque exerted on drive inputs 73 would transfer tension tothe tendon, thereby causing the end effector to actuate in some way. Insome embodiments, during a surgical procedure, the tendon may cause ajoint to rotate about an axis, thereby causing the end effector to movein one direction or another. Alternatively, the tendon may be connectedto one or more jaws of a grasper at the distal end of the elongatedshaft 71, where tension from the tendon causes the grasper to close.

In endoscopy, the tendons may be coupled to a bending or articulatingsection positioned along the elongated shaft 71 (e.g., at the distalend) via adhesive, control ring, or other mechanical fixation. Whenfixedly attached to the distal end of a bending section, torque exertedon the drive inputs 73 would be transmitted down the tendons, causingthe softer, bending section (sometimes referred to as the articulablesection or region) to bend or articulate. Along the non-bendingsections, it may be advantageous to spiral or helix the individual pulllumens that direct the individual tendons along (or inside) the walls ofthe endoscope shaft to balance the radial forces that result fromtension in the pull wires. The angle of the spiraling and/or spacingtherebetween may be altered or engineered for specific purposes, whereintighter spiraling exhibits lesser shaft compression under load forces,while lower amounts of spiraling results in greater shaft compressionunder load forces, but limits bending. On the other end of the spectrum,the pull lumens may be directed parallel to the longitudinal axis of theelongated shaft 71 to allow for controlled articulation in the desiredbending or articulable sections.

In endoscopy, the elongated shaft 71 houses a number of components toassist with the robotic procedure. The shaft 71 may comprise a workingchannel for deploying surgical tools (or medical instruments),irrigation, and/or aspiration to the operative region at the distal endof the shaft 71. The shaft 71 may also accommodate wires and/or opticalfibers to transfer signals to/from an optical assembly at the distaltip, which may include an optical camera. The shaft 71 may alsoaccommodate optical fibers to carry light from proximally-located lightsources, such as light emitting diodes, to the distal end of the shaft71.

At the distal end of the instrument 70, the distal tip may also comprisethe opening of a working channel for delivering tools for diagnosticand/or therapy, irrigation, and aspiration to an operative site. Thedistal tip may also include a port for a camera, such as a fiberscope ora digital camera, to capture images of an internal anatomical space.Relatedly, the distal tip may also include ports for light sources forilluminating the anatomical space when using the camera.

In the example of FIG. 16, the drive shaft axes, and thus the driveinput axes, are orthogonal to the axis of the elongated shaft 71. Thisarrangement, however, complicates roll capabilities for the elongatedshaft 71. Rolling the elongated shaft 71 along its axis while keepingthe drive inputs 73 static results in undesirable tangling of thetendons as they extend off the drive inputs 73 and enter pull lumenswithin the elongated shaft 71. The resulting entanglement of suchtendons may disrupt any control algorithms intended to predict movementof the flexible elongated shaft 71 during an endoscopic procedure.

FIG. 17 illustrates an alternative design for an instrument driver andinstrument where the axes of the drive units are parallel to the axis ofthe elongated shaft of the instrument. As shown, a circular instrumentdriver 80 comprises four drive units with their drive outputs 81 alignedin parallel at the end of a robotic arm 82. The drive units, and theirrespective drive outputs 81, are housed in a rotational assembly 83 ofthe instrument driver 80 that is driven by one of the drive units withinthe assembly 83. In response to torque provided by the rotational driveunit, the rotational assembly 83 rotates along a circular bearing thatconnects the rotational assembly 83 to the non-rotational portion 84 ofthe instrument driver 80. Power and controls signals may be communicatedfrom the non-rotational portion 84 of the instrument driver 80 to therotational assembly 83 through electrical contacts that may bemaintained through rotation by a brushed slip ring connection (notshown). In other embodiments, the rotational assembly 83 may beresponsive to a separate drive unit that is integrated into thenon-rotatable portion 84, and thus not in parallel to the other driveunits. The rotational mechanism 83 allows the instrument driver 80 torotate the drive units, and their respective drive outputs 81, as asingle unit around an instrument driver axis 85.

Like earlier disclosed embodiments, an instrument 86 may comprise anelongated shaft portion 88 and an instrument base 87 (shown with atransparent external skin for discussion purposes) comprising aplurality of drive inputs 89 (such as receptacles, pulleys, and spools)that are configured to receive the drive outputs 81 in the instrumentdriver 80. Unlike prior disclosed embodiments, the instrument shaft 88extends from the center of the instrument base 87 with an axissubstantially parallel to the axes of the drive inputs 89, rather thanorthogonal as in the design of FIG. 16.

When coupled to the rotational assembly 83 of the instrument driver 80,the medical instrument 86, comprising instrument base 87 and instrumentshaft 88, rotates in combination with the rotational assembly 83 aboutthe instrument driver axis 85. Since the instrument shaft 88 ispositioned at the center of instrument base 87, the instrument shaft 88is coaxial with instrument driver axis 85 when attached. Thus, rotationof the rotational assembly 83 causes the instrument shaft 88 to rotateabout its own longitudinal axis. Moreover, as the instrument base 87rotates with the instrument shaft 88, any tendons connected to the driveinputs 89 in the instrument base 87 are not tangled during rotation.Accordingly, the parallelism of the axes of the drive outputs 81, driveinputs 89, and instrument shaft 88 allows for the shaft rotation withouttangling any control tendons.

FIG. 18 illustrates an instrument having an instrument based insertionarchitecture in accordance with some embodiments. The instrument 150 canbe coupled to any of the instrument drivers discussed above. Theinstrument 150 comprises an elongated shaft 152, an end effector 162connected to the shaft 152, and a handle 170 coupled to the shaft 152.The elongated shaft 152 comprises a tubular member having a proximalportion 154 and a distal portion 156. The elongated shaft 152 comprisesone or more channels or grooves 158 along its outer surface. The grooves158 are configured to receive one or more wires or cables 180therethrough. One or more cables 180 thus run along an outer surface ofthe elongated shaft 152. In other embodiments, cables 180 can also runthrough the elongated shaft 152. Manipulation of the one or more cables180 (e.g., via an instrument driver) results in actuation of the endeffector 162.

The instrument handle 170, which may also be referred to as aninstrument base, may generally comprise an attachment interface 172having one or more mechanical inputs 174, e.g., receptacles, pulleys orspools, that are designed to be reciprocally mated with one or moretorque couplers on an attachment surface of an instrument driver.

In some embodiments, the instrument 150 comprises a series of pulleys orcables that enable the elongated shaft 152 to translate relative to thehandle 170. In other words, the instrument 150 itself comprises aninstrument-based insertion architecture that accommodates insertion ofthe instrument, thereby minimizing the reliance on a robot arm toprovide insertion of the instrument 150. In other embodiments, a roboticarm can be largely responsible for instrument insertion.

E. Controller.

Any of the robotic systems described herein can include an input deviceor controller for manipulating an instrument attached to a robotic arm.In some embodiments, the controller can be coupled (e.g.,communicatively, electronically, electrically, wirelessly and/ormechanically) with an instrument such that manipulation of thecontroller causes a corresponding manipulation of the instrument e.g.,via master slave control.

FIG. 19 is a perspective view of an embodiment of a controller 182. Inthe present embodiment, the controller 182 comprises a hybrid controllerthat can have both impedance and admittance control. In otherembodiments, the controller 182 can utilize just impedance or passivecontrol. In other embodiments, the controller 182 can utilize justadmittance control. By being a hybrid controller, the controller 182advantageously can have a lower perceived inertia while in use.

In the illustrated embodiment, the controller 182 is configured to allowmanipulation of two medical instruments, and includes two handles 184.Each of the handles 184 is connected to a gimbal 186. Each gimbal 186 isconnected to a positioning platform 188.

As shown in FIG. 19, each positioning platform 188 includes a SCARA arm(selective compliance assembly robot arm) 198 coupled to a column 194 bya prismatic joint 196. The prismatic joints 196 are configured totranslate along the column 194 (e.g., along rails 197) to allow each ofthe handles 184 to be translated in the z-direction, providing a firstdegree of freedom. The SCARA arm 198 is configured to allow motion ofthe handle 184 in an x-y plane, providing two additional degrees offreedom.

In some embodiments, one or more load cells are positioned in thecontroller. For example, in some embodiments, a load cell (not shown) ispositioned in the body of each of the gimbals 186. By providing a loadcell, portions of the controller 182 are capable of operating underadmittance control, thereby advantageously reducing the perceivedinertia of the controller while in use. In some embodiments, thepositioning platform 188 is configured for admittance control, while thegimbal 186 is configured for impedance control. In other embodiments,the gimbal 186 is configured for admittance control, while thepositioning platform 188 is configured for impedance control.Accordingly, for some embodiments, the translational or positionaldegrees of freedom of the positioning platform 188 can rely onadmittance control, while the rotational degrees of freedom of thegimbal 186 rely on impedance control.

F. Navigation and Control.

Traditional endoscopy may involve the use of fluoroscopy (e.g., as maybe delivered through a C-arm) and other forms of radiation-based imagingmodalities to provide endoluminal guidance to an operator physician. Incontrast, the robotic systems contemplated by this disclosure canprovide for non-radiation-based navigational and localization means toreduce physician exposure to radiation and reduce the amount ofequipment within the operating room. As used herein, the term“localization” may refer to determining and/or monitoring the positionof objects in a reference coordinate system. Technologies such aspreoperative mapping, computer vision, real-time EM tracking, and robotcommand data may be used individually or in combination to achieve aradiation-free operating environment. In other cases, whereradiation-based imaging modalities are still used, the preoperativemapping, computer vision, real-time EM tracking, and robot command datamay be used individually or in combination to improve upon theinformation obtained solely through radiation-based imaging modalities.

FIG. 20 is a block diagram illustrating a localization system 90 thatestimates a location of one or more elements of the robotic system, suchas the location of the instrument, in accordance to an exampleembodiment. The localization system 90 may be a set of one or morecomputer devices configured to execute one or more instructions. Thecomputer devices may be embodied by a processor (or processors) andcomputer-readable memory in one or more components discussed above. Byway of example and not limitation, the computer devices may be in thetower 30 shown in FIG. 1, the cart 11 shown in FIGS. 1-4, the beds shownin FIGS. 5-14, etc.

As shown in FIG. 20, the localization system 90 may include alocalization module 95 that processes input data 91-94 to generatelocation data 96 for the distal tip of a medical instrument. Thelocation data 96 may be data or logic that represents a location and/ororientation of the distal end of the instrument relative to a frame ofreference. The frame of reference can be a frame of reference relativeto the anatomy of the patient or to a known object, such as an EM fieldgenerator (see discussion below for the EM field generator).

The various input data 91-94 are now described in greater detail.Preoperative mapping may be accomplished through the use of thecollection of low dose CT scans. Preoperative CT scans are reconstructedinto three-dimensional images, which are visualized, e.g. as “slices” ofa cutaway view of the patient's internal anatomy. When analyzed in theaggregate, image-based models for anatomical cavities, spaces andstructures of the patient's anatomy, such as a patient lung network, maybe generated. Techniques such as center-line geometry may be determinedand approximated from the CT images to develop a three-dimensionalvolume of the patient's anatomy, referred to as model data 91 (alsoreferred to as “preoperative model data” when generated using onlypreoperative CT scans). The use of center-line geometry is discussed inU.S. patent application Ser. No. 14/523,760, the contents of which areherein incorporated in its entirety. Network topological models may alsobe derived from the CT-images, and are particularly appropriate forbronchoscopy.

In some embodiments, the instrument may be equipped with a camera toprovide vision data (or image data) 92. The localization module 95 mayprocess the vision data 92 to enable one or more vision-based (orimage-based) location tracking modules or features. For example, thepreoperative model data 91 may be used in conjunction with the visiondata 92 to enable computer vision-based tracking of the medicalinstrument (e.g., an endoscope or an instrument advance through aworking channel of the endoscope). For example, using the preoperativemodel data 91, the robotic system may generate a library of expectedendoscopic images from the model based on the expected path of travel ofthe endoscope, each image linked to a location within the model.Intraoperatively, this library may be referenced by the robotic systemin order to compare real-time images captured at the camera (e.g., acamera at a distal end of the endoscope) to those in the image libraryto assist localization.

Other computer vision-based tracking techniques use feature tracking todetermine motion of the camera, and thus the endoscope. Some features ofthe localization module 95 may identify circular geometries in thepreoperative model data 91 that correspond to anatomical lumens andtrack the change of those geometries to determine which anatomical lumenwas selected, as well as the relative rotational and/or translationalmotion of the camera. Use of a topological map may further enhancevision-based algorithms or techniques.

Optical flow, another computer vision-based technique, may analyze thedisplacement and translation of image pixels in a video sequence in thevision data 92 to infer camera movement. Examples of optical flowtechniques may include motion detection, object segmentationcalculations, luminance, motion compensated encoding, stereo disparitymeasurement, etc. Through the comparison of multiple frames overmultiple iterations, movement and location of the camera (and thus theendoscope) may be determined.

The localization module 95 may use real-time EM tracking to generate areal-time location of the endoscope in a global coordinate system thatmay be registered to the patient's anatomy, represented by thepreoperative model. In EM tracking, an EM sensor (or tracker) comprisingone or more sensor coils embedded in one or more locations andorientations in a medical instrument (e.g., an endoscopic tool) measuresthe variation in the EM field created by one or more static EM fieldgenerators positioned at a known location. The location informationdetected by the EM sensors is stored as EM data 93. The EM fieldgenerator (or transmitter), may be placed close to the patient to createa low intensity magnetic field that the embedded sensor may detect. Themagnetic field induces small currents in the sensor coils of the EMsensor, which may be analyzed to determine the distance and anglebetween the EM sensor and the EM field generator. These distances andorientations may be intraoperatively “registered” to the patient anatomy(e.g., the preoperative model) in order to determine the geometrictransformation that aligns a single location in the coordinate systemwith a position in the preoperative model of the patient's anatomy. Onceregistered, an embedded EM tracker in one or more positions of themedical instrument (e.g., the distal tip of an endoscope) may providereal-time indications of the progression of the medical instrumentthrough the patient's anatomy.

Robotic command and kinematics data 94 may also be used by thelocalization module 95 to provide localization data 96 for the roboticsystem. Device pitch and yaw resulting from articulation commands may bedetermined during preoperative calibration. Intraoperatively, thesecalibration measurements may be used in combination with known insertiondepth information to estimate the position of the instrument.Alternatively, these calculations may be analyzed in combination withEM, vision, and/or topological modeling to estimate the position of themedical instrument within the network.

As FIG. 20 shows, a number of other input data can be used by thelocalization module 95. For example, although not shown in FIG. 20, aninstrument utilizing shape-sensing fiber can provide shape data that thelocalization module 95 can use to determine the location and shape ofthe instrument.

The localization module 95 may use the input data 91-94 incombination(s). In some cases, such a combination may use aprobabilistic approach where the localization module 95 assigns aconfidence weight to the location determined from each of the input data91-94. Thus, where the EM data may not be reliable (as may be the casewhere there is EM interference) the confidence of the locationdetermined by the EM data 93 can be decrease and the localization module95 may rely more heavily on the vision data 92 and/or the roboticcommand and kinematics data 94.

As discussed above, the robotic systems discussed herein may be designedto incorporate a combination of one or more of the technologies above.The robotic system's computer-based control system, based in the tower,bed and/or cart, may store computer program instructions, for example,within a non-transitory computer-readable storage medium such as apersistent magnetic storage drive, solid state drive, or the like, that,upon execution, cause the system to receive and analyze sensor data anduser commands, generate control signals throughout the system, anddisplay the navigational and localization data, such as the position ofthe instrument within the global coordinate system, anatomical map, etc.

2. Introduction to Systems and Methods for Adjusting Medical DeviceRemote Center

Embodiments of the disclosure relate to systems and techniques foradjusting the remote center of motion (also referred to simply as a“remote center”) for a medical instrument and/or corresponding cannula.In particular, aspects of this disclosure relate to a collection ofsystems and techniques which can achieve improved set-ups for differenttypes of surgeries, better reach of robotic arms, and collisionavoidance. In some implementations, these benefits can be achieved byproviding techniques for setting up and accommodating different remotecenters, even within a single treatment episode.

As used herein, a remote center of motion (RCM) generally refers to apoint in space where a cannula or other access port is constrained inmotion. FIG. 21 illustrates exemplary movement of an ADM 125 whilemaintaining a remote center of motion in accordance with aspects of thisdisclosure. FIG. 21 illustrates the ADM 125, an instrument 130, and adistal end 135 of the instrument 130. In particular, FIG. 21 illustratesthe movement of the ADM 125 from a first position 100A to a secondposition 100B while maintaining a remote center of motion 120. The ADM125 can be coupled to a distal end of a robotic arm (such as those shownin FIG. 14) configured to control movement of the ADM 125 and the distalend 135 of the instrument 130. For example, in maintaining the remotecenter of motion 120, a robotic arm may be configured to rotate the ADM125 and the instrument 130 about the remote center of motion such thatthe remote center of motion is stationary.

The robotic arm and/or surgical system can establish and maintain theposition of the remote center of motion 120 for the instrument 130and/or for an access port (such as a cannula). Depending on theimplementation, the remote center of motion 120 can be maintained eithermechanically or by software executed on one or more processors of thesystem. During a surgical procedure, the instrument 130 may be insertedthrough the patient's body wall to gain access to an internal region ofthe patient, via a cannula or other access port. In manyimplementations, the remote center of motion 120 can be located at theintersection between the body wall and the instrument 130 in order toprevent and/or reduce movement of the body wall during the procedure,thereby enabling the surgical procedure to safely take place. Forexample, if the location of the intersection between the instrument 130is not held substantially stationary during the procedure, theinstrument 130 may apply unnecessary force to the body wall, potentiallytearing the body wall. Thus, it is desirable to maintain the remotecenter of motion 120 to prevent unnecessary forces from being applied tothe body wall.

FIG. 22 illustrates an ADM 205 prior to docking of the ADM to a cannula235 in accordance with aspects of this disclosure. In the illustratedimplementation, the system includes the ADM 205, a tool path 210associated with the ADM 205, an image sensor 225 having an associatedfield of view 230, a cannula 235, a body wall 245 of a patient, and apoint of intersection 250 between the port 235 and the body wall 245.The ADM 205 is attached to the distal end of a robotic arm (notillustrated) configured to control movement of the ADM 205 and aninstrument (not illustrated) which can be inserted and retracted alongthe tool path 210. In the present implementation, the image sensor 225is shown coupled to an outer side wall of the ADM 205, while in otherembodiments, the image sensor 225 can be found within the body of theADM 205 itself. In some implementations, the image sensor 225 can bedetachably coupled with the ADM 205, while in other implementations, theimage sensor 225 can be integrated with the ADM 205.

In some implementations, the remote center of motion passes through thebody wall 245 of a patient via the cannula 235. The remote center ofmotion is positioned along the tool path 210 of an instrument/tool thatcoupled to the ADM 205. The cannula 235 and instrument can pivot at theremote center. In traditional procedures, the location of the remotecenter does not change during a surgery, since there is a risk of traumato the patient when the remote center moves. For example, movement ofthe remote center of motion laterally with respect to the body wall mayexert undesired forces onto the body wall, risking trauma to thepatient.

A remote center distance generally refers to the distance from aninterface of the cannula and the robotic arm to the remote center. Insome embodiments, the interface can be a point where the cannula ismounted on a distal end of the robotic arm (e.g., such as on an ADM). Insome implementations, the remote center distance can be defined as thedistance between the ADM 205 midplane (e.g., a plane perpendicular tothe tool path 210) and the remote center (e.g., which can be located atthe point of intersection 250 in FIG. 22). When the ADM 205 is coupledto the cannula 235, the remote center distance can be defined as thedistance between: (i) the interface between the ADM 205 and the cannula235 and (ii) the remote center.

In a robotic system that utilizes a plurality of robotic arms (e.g.,three arms on each side of the patient, for a total of six arms) toperform very complex surgeries, there may be a number of challenges:

(a) Optimization for multiple poses. The positioning of robotic arms andthe corresponding cannulas will often need to be optimized for differentposes depending on the type of surgery.

(b) Arm reach and collision avoidance. In many types of medicalprocedures, a robotic arm that holds a camera (e.g., a camera arm) mayneed to position a laparoscope in or near a midline of a patient. Forcertain medical procedures, it can be a challenge for one or more of therobotic arms to reach the desired position of a corresponding cannula orother access port. For example, a first robotic arm may be able to reachthe corresponding cannula on its own, however, when a plurality of otherrobotic arms are attached to the same bar (e.g., see bar 107 illustratedin FIGS. 12-14), the competing constraints of collision avoidance andport placement may result the first robotic arm being undesirablyoutstretched or even unable to reach the corresponding cannula. Thistype of arm reach an collision avoidance can be limiting to both on armreach/range of motion and on performance (e.g., an outstretched arm maybe prone to shaking and overheating).

(c) Tight cannula/port spacing. In smaller patients and smaller targetworkspaces, the cannulas and/or access ports may have to be spacedrelatively close together. FIGS. 23A and 23B illustrate example remotecenter distances which can be used to determine minimum port spacing inaccordance with aspects of this disclosure. With reference to FIGS. 23Aand 23B, a minimum port spacing can be defined by the tangency betweencones 315 and 335 centered at the remote center 320 and 340 andenveloping the ADM 305 and 325. As shown in FIGS. 23A and 23B, theremote center for the ADM 305 of FIG. 23A is closer than the remotecenter for the ADM 325 of FIG. 23B. When the remote center 340 isfarther from the ADM 325 (e.g., a larger remote center distance as inFIG. 23B), the cone is narrower and the cannulas 330 can be placedcloser together than in the case where the remote center 320 is closerto the ADM 305 as in FIG. 23A.

Aspects of this disclosure relate to systems and methods that canaccommodate multiple poses of robotic arms for different types ofsurgeries, while providing enhanced reach for the robotic arm and/orcollision avoidance.

A. Variable Remote Center Distances and Adjustable Remote CenterDistances

Aspects of this disclosure relate to robotic systems that utilizemultiple robotic arms (e.g., three arms on each side of a patient) toperform very complex medical procedures. The robotic arms can bedesigned to be optimized for a variety of different poses depending onthe type of medical procedure to be performed. These poses can imposedifferent optimization constraints on one or more of the robotic arms'remote center distances. Example optimization constraints may includevariables such as the spacing between ports/cannulas, the extension of arobotic arm to reach a port/cannula, collision avoidance, poseoptimization (e.g., for singularity avoidance, to improve naturalfrequency, to maximize workspace, etc.), and instrument reach. In orderto accommodate these optimization constraints, the system can enable oneor more of the robotic arms to have a variable remote center distance,even within a single treatment episode.

One example medical procedure which may involve the use of variableremote center distances is a partial nephrectomy. FIG. 24 illustrates arobotic medical system 400 with a plurality of robotic arms in positionto perform a portion of a partial nephrectomy surgical procedure inaccordance with aspects of this disclosure. Each of the robotic arms mayinclude an instrument driver and a plurality of robotic joints. Each ofthe robotic arms may further be configured to manipulate a correspondingtool that passes through a cannula coupled to the robotic arm.

As shown in FIG. 24, a patient may be placed on his/her side on aplatform 410 of the system 400 during a partial nephrectomy. A first setof robotic arms 415 can reach both above and around the patient 405,while a second set of robotic arms 420 can reach upwards and below thepatient 405. The first set of robotic arms 415 that reach above andaround a patient may benefit from a relatively short remote centerdistance, which can help to reduce the arm reach distance for the firstset of arm arms 415. For example, when one of the first set of roboticarms 415 reaches at least partially around the patient, an increase inthe remote center distance can result in a longer required reach for therobotic arm 415 to maintain the remote center distance. Thus, by using arelatively shorter remote center distance for the first set of roboticarms 415, the first set of robotic arms 415 may not be required toextend as far as if a longer remote center distance was used. Since anoutstretched robotic arm may not be as stable as a robotic arm that isless stretched out, the use of a shorter remote center distance for thefirst set of robotic arms 415 can improve the stability of the first setof robotic arms 415 during the partial nephrectomy.

For the second set of robotic arms 420 that reach upwards and below thepatient 420, a longer remote center distance may allow the second set ofrobotic arms 420 to spread and reduce the risk of collisions. As isdiscussed in detail below (see FIGS. 28A and 28B), a longer remotecenter distance can reduce the likelihood of a collision between ADMs ofadjacent robotic arms for the same distance between cannula locations.Thus, for a procedure such as the partial nephrectomy illustrated inFIG. 24, it can be beneficial for one or more of the robotic arms 415 tohave a longer remote center distance than other robotic arms 420 of thesystem.

FIG. 25 is a flowchart illustrating an example method operable by arobotic system, or component(s) thereof, for maintaining two differentremove center distances in accordance with aspects of this disclosure.For example, the steps of method 500 illustrated in FIG. 25 may beperformed by processor(s) and/or other component(s) of a medical roboticsystem (e.g., robotically-enabled system 10) or associated system(s).For convenience, the method 500 is described as performed by the“system” in connection with the description of the method 500.

The method 500 begins at block 501. At block 505, the system maymaintain a first remote center distance between an interface between afirst robotic arm and a first cannula coupled to the first robotic arm,and a first remote center of motion. The first robotic arm is configuredto insert a first medical tool through the first cannula. The firstrobotic arm can be coupled to the first cannula.

At block 510, the system may maintain a second remote center distancebetween an interface between a second robotic arm and a second cannulacoupled to the second robotic arm, and a second remote center of motion.The second robotic arm is configured to insert a second medical toolthrough the second cannula. The second robotic arm can be coupled to thesecond cannula. The first remote center distance is different from thesecond remote center distance. For example, when performing a partialnephrectomy as illustrated in FIG. 24, the first robotic arm maycorrespond to one of the robotic arms 415 and the second robotic arm maycorrespond to one of the robotic arms 420. Thus, the system can maintaindifferent remote center distances for the first and second robotic armswhen performing medical procedures such as partial nephrectomy. Themethod 500 ends at block 515.

For certain medical procedures, it may also be desirable to adjust theremote center distance for one or more robotic arms during a medicalprocedure. For example, by shortening the remote center distance, thesystem may be able to increase a maximum distance the medical tool isable to be inserted into the patient. Adjusting the remote centerdistance for a robotic arm may also provide a null-space DoF. As usedherein, null-space movement can refer to the movement of a robotic armwhile maintaining the pose (e.g., position and orientation) of thedistal end of a medical instrument. Movement of a robotic arm in thenull-space can allow for active collision avoidance between arms withoutaffecting the desired pose of an end effector of the medical instrument.In some embodiments, it may also be desirable to adjust the remotecenter distance for one or more robotic arms from one procedure toanother. In one embodiment, it may be desirable to adjust the remotecenter distance for a plurality of robotic arms, wherein the remotecenter distance associated with the plurality of robotic arms is changedsimultaneously.

For certain poses of a robotic arm, the robotic arm may have anull-space DoF that is discontinuous. For example, the null-space DoFmay form a straight line in space, however, the line may bediscontinuous when movement along the line would result in a pose of therobotic arm that cannot be performed. By providing an additionalnull-space DoF involving adjusting the remote center of motion, therobotic arm may be able to connect the previously discontinuousnull-space DoF allowing for more null-space freedom of movement whichcan be used, for example, in collision avoidance.

Movement of the remote center and/or adjusting the remote centerdistance can also be used to achieve “port bumping.” For example, thecannula can be used to expand and/or reshape the body wall by exerting aforce on the body wall, which can provide additional access to aninternal anatomy of the patient. Enlarging the cavity formed duringsurgery using port bumping may be referred to generally as “tenting.”Thus, the DoF provided by remote center distance adjustment can also aidin performing port bumping.

In addition, adjustment of the remote center distance can be of use insetting up a robotic medical system for performing a procedure on abariatric patient. For example, a bariatric patient may have asufficiently thick body wall such that regardless of the location of theremote center of motion, forces will be exerted on portions of thepatient's body wall. However, the patient's muscle wall may be moresensitive to lateral forces than the remainder of the patient's bodywall. Thus, the remote center distance can be adjusted such that theremote center is located at the bariatric patient's muscle wall,reducing the risk of trauma to the patient as the medical instrument andcannula are rotated about the remote center of motion. In someembodiments, the robotic system can use force measurements on one ormore robotic arms to estimate where the best remote center is that willapply the least amount of force to the body wall and automaticallyadjust the remote center to be at that point.

FIG. 26 is a flowchart illustrating an example method operable by arobotic system, or component(s) thereof, for adjusting a remote centerdistance in accordance with aspects of this disclosure. For example, thesteps of method 600 illustrated in FIG. 26 may be performed byprocessor(s) and/or other component(s) of a medical robotic system(e.g., robotically-enabled system 10) or associated system(s). Forconvenience, the method 600 is described as performed by the “system” inconnection with the description of the method 600.

The method 600 begins at block 601. At block 605, the system may providea robotic arm comprising a drive mechanism. The robotic arm isassociated with a cannula and a remote center of motion. The robotic armand the remote center of motion have a remote center distance therebetween. At block 610, the system may adjust the remote center distancebetween the robotic arm and the remote center of motion. In someimplementations, the adjustment of the remote center distance can beperformed to increase a maximum distance the medical tool is able to beinserted into the patient. The method 600 ends at block 615.

FIGS. 27A-27E illustrate an example of using remote center distanceadjustment to increase a maximum distance that a medial tool can beinserted into a patient in accordance with aspects of this disclosure.Referring to FIG. 27A, an ADM 705 can insert a medical tool 710, througha patient's body wall 715 via a cannula 717. A robotic medical systemcan enforce a remote center of motion 720 around which the ADM 705,cannula 717, and medical tool 710 can rotate as illustrated by theghosted ADM 705, cannula 717, and medical tool 710. During an examplemedical procedure, a user may drive the medical tool 710 such that anend effector 725 can reach a target site 730 (e.g., a nodule, portion ofan anatomy, etc.).

FIG. 27B illustrates driving the medical tool 710 towards the targetsite 730 while maintaining the remote center 720, as shown by the arrow.As illustrated in FIG. 27C, the user may run out of working length ofthe medical tool 710 before the end effector 725 reaches the target site730. In order to reach the target site 730, the user can use thenull-space DoF provided by the remote center distance to further insertthe cannula 717 along with the medical tool 710 into the patient, whilemaintaining the position of the remote center 720 with respect to thepatient's body wall 715 as shown in FIG. 27D. This may involve reducingthe remote center distance such that an interface between the ADM 705and the cannula 717 can be brought closer to the body wall 715. Thus,the system may dynamically adjust the position of the cannula 717 withrespect to the body wall 715. The user can pivot the ADM 705, cannula717, and medical tool 710 about the new remote center 720, allowing foran increased maximum distance that the medical tool 710 can be insertedinto the patient, as shown in FIG. 27E.

B. Setting Up and Accommodating Different Remote Center Distances

There may be a number of techniques for maintaining remote centerdistances that vary between one or more cannulas or ports within asingle procedure or treatment episode and/or for adjusting the remotecenter distance for a robotic arm/cannula during a medical procedure.

In certain implementations, the system can use a mechanical-basedtechnique for setting different remote center distances. FIGS. 28A and28B illustrate an example mechanical-based technique for setting remotecenter distances in accordance with aspects of this disclosure.Specifically, different remote center distances can be set usingcannulas having different lengths. For example, the mechanical-basedtechnique can involve setting and accommodating different remote centerdistances by providing different cannula lengths (e.g., a first cannula810 and a second cannula 820 in FIG. 28B) with discrete remote centerdistances that vary according to the cannula lengths. By providingcannulas with discrete and different remote center distances, aspects ofthis disclosure can provide systems advantageously capable of performingmedical procedures or surgeries (e.g., such as partial nephrectomy)using remote center distances that can vary port-to-port.

The use of different length cannulas that provide different remotecenter distances can also affect the risk of collision between adjacentADMs. For example, FIG. 28A illustrates two closely spaced cannulas 815which have the same length. The cannulas 815 are mechanically coupled toADMs 810 which are configured to insert medical tools 805 therethrough.When the cannulas 815 have the same length and the same remote centerdistance, the risk of collision between the ADMs 810 is higher comparedto cannulas having different lengths and remove center distances asshown in FIG. 28B. That is, due to the cones formed between the remotecenter and the ADMs 810 (e.g., see cones 315 and 335 of FIGS. 23A and23B), the ADMs 810 in FIG. 28A may collide when the cannulas 815 arestill relatively far apart. For example, the distances at two selectedlocations along the cannulas 815 at or close to a collision are shown inFIG. 28A as 3.5 cm and 5.6 cm.

In contrast, when a first cannula 815 and a second cannula 820 areprovided having different lengths and remote center distances asillustrated in FIG. 28B, the first and second cannulas 815 and 820 maybe able to be positioned closer together before the ADMs 810 collidecompared to the FIG. 28A implementation. Thus, the risk of collisionbetween the ADMs 810 in FIG. 28B may be less than the risk of collisionbetween the ADMs in FIG. 28A, given the same spacing between thecannulas 815 and 820. In the example of FIG. 28B, the distances at thetwo selected locations along the first and second cannulas 815 and 820at or close to a collision are 3.0 cm and 4.0 cm. Since a longer remotecenter distance can reduce the risk of collisions, longer remote centerdistances may be advantageous when working on smaller patients or in amore confined medical area, allowing closer port spacing whilemitigating some of the collision risks typically associated with suchclose port spacing.

FIG. 29 illustrates an example surgical procedure using cannulas ofdifferent lengths in accordance with aspects of this disclosure. Inparticular, the system 900 includes a first set of robotic arms 905configured to control movement of a first set of medical tools through afirst set of cannulas 910, a second set of robotic arms 915 configuredto control movement of a second set of medical tools through a secondset of cannulas 920, and a third robotic arm 925 configured to controlmovement of a camera through a third cannula 930. For certainprocedures, as illustrated in FIG. 29, it may be advantageous to locatethe camera centrally with respect to the other medical tools/cannulas910 and 920 so that the camera can be positioned to provide a view ofany portion of the anatomy within reach of the medical tools. Due to theclose placement of the cannula 930 corresponding to the camera and thecannulas 920 corresponding to the medical tools, it can be advantageousto provide a longer cannula 930 than the cannulas 920, allowing greaterrange of motion and reducing the risk of collision, as described inconnection with FIGS. 28A and 28B.

In addition to or in place of the use of different length cannulas torealize different remote center distances between different portlocations, the system may further be configured to adjust and/ormaintain remote center distances using software. That is, the system canenforce the static location of a remote center for a given robotic armand cannula when calculating movement of the robotic arm to achieve adesired movement of the corresponding medical instrument. The system mayfurther be configured to maintain different remote center distances fortwo or more robotic arms/cannulas and/or adjust the remote centerdistance to a single robotic arm/cannula.

The use of software-based setting of different remote center distancescan enable the system to, for example, move a robotic arm in anull-space DoF and/or increase a maximum distance the medical tool isable to be inserted into the patient. Rather than relying solely onmechanical mechanisms to set up and accommodate different remotecenters, aspects of this disclosure enable the system to use algorithmsthat will set different remote center distances amongst different portsand robotic arms. In addition, the system can be configured to usesoftware-based remote center setting to adjust a remote center distanceat a single port location by allowing for adjustment of the remotecenter distance. Using such software-based remote center distancesetting to enable movement within a null-space DoF can allow for moreflexibility in adjusting the poses of the robotic arms to stay out ofeach other's way, providing additional options for active collisionavoidance between robotic arms. In some implementations, the system maybe configured to determine that movement of a first robotic arm and arobotic arm are within a threshold distance of a collision and adjustone or more of a first remote center distance associated with the firstrobotic arm and a second remote center distance associated with thesecond robotic arm to reduce the likelihood of a collision therebetween.

In addition to the automatic adjustment of a remote center distance bythe system, for example during collision avoidance, in someimplementations, the system may also be configured to allow a user tomanually adjust a remote center distance. For example, the system may beable to accept input from a user via a user input device (e.g., thecontroller 182 of FIG. 19) to adjust a remote center distance. Inanother example, the system may be configured to accept input from auser in an “input mode” where the user provides input in the form of aforce applied directly to the robotic arm. The system may be configuredto accept a user command to enter a mode for adjusting the remote centerdistance in via an input or button on the robotic arm and interpretforces exerted on the robotic arm by the user as input for adjusting theremote center distance.

In some embodiments, using the remote center as a null-space DoF can befurther enhanced by allowing operation without the cannula beingmechanically latched to the ADM of the robotic arm. FIGS. 30A and 30Billustrate examples of an ADM being latched and unlatched from acorresponding cannula in accordance with aspects of this disclosure.Referring to FIG. 30A, the robotic medical system may include a firstrobotic arm 1005 configured to control movement of a first medicalinstrument 1025, which may include a camera, and a second robotic arm1010 configured to control movement of a second medical instrument. Thefirst robotic arm 1005 may include an ADM 1020 at a distal end thereofwhich is mechanically coupled to a cannula 1015, for example, via alatch. Due to the mechanical coupling between the ADM 1020 and thecannula 1015, the range or motion available to the first robotic arm maybe constrained. Thus, movement of the second robotic arm 1010 (e.g., ina yaw DoF) towards the first robotic arm 1005 may be constrained due tothe risk of collision therebetween.

In contrast, in the implementation of FIG. 30B, the ADM 1020 isuncoupled from the cannula 1015. Thus, the first robotic arm 1005 canfreely move the ADM 1020 farther away from the cannula 1015, providingadditional space for the second robotic arm 1010 to move beforecontacting the first robotic arm 1005. In certain implementations, thesystem may be configured to actively move the first robotic arm 1005 toavoid a collision with the second robotic arm 1010 by taking advantageof the additional null-space range of motion provided by the ADM 1020being uncoupled from the cannula 1015. The system may be configured suchthat to allow for the remote center distance to the infinitelyadjustable, while maintaining the position of the remote center. Thus,in certain implementations, the only limits to adjustment of the remotecenter distance may be physical limitations of the robotic system (e.g.,robotic arm length, power available from motor(s) controlling movementof the robotic arms, etc.).

3. Implementing Systems and Terminology

Implementations disclosed herein provide systems, methods and apparatusfor adjusting medical device remote center distances.

It should be noted that the terms “couple,” “coupling,” “coupled” orother variations of the word couple as used herein may indicate eitheran indirect connection or a direct connection. For example, if a firstcomponent is “coupled” to a second component, the first component may beeither indirectly connected to the second component via anothercomponent or directly connected to the second component.

The functions for adjusting remote center distance described herein maybe stored as one or more instructions on a processor-readable orcomputer-readable medium. The term “computer-readable medium” refers toany available medium that can be accessed by a computer or processor. Byway of example, and not limitation, such a medium may comprise randomaccess memory (RAM), read-only memory (ROM), electrically erasableprogrammable read-only memory (EEPROM), flash memory, compact discread-only memory (CD-ROM) or other optical disk storage, magnetic diskstorage or other magnetic storage devices, or any other medium that canbe used to store desired program code in the form of instructions ordata structures and that can be accessed by a computer. It should benoted that a computer-readable medium may be tangible andnon-transitory. As used herein, the term “code” may refer to software,instructions, code or data that is/are executable by a computing deviceor processor.

The methods disclosed herein comprise one or more steps or actions forachieving the described method. The method steps and/or actions may beinterchanged with one another without departing from the scope of theclaims. In other words, unless a specific order of steps or actions isrequired for proper operation of the method that is being described, theorder and/or use of specific steps and/or actions may be modifiedwithout departing from the scope of the claims.

As used herein, the term “plurality” denotes two or more. For example, aplurality of components indicates two or more components. The term“determining” encompasses a wide variety of actions and, therefore,“determining” can include calculating, computing, processing, deriving,investigating, looking up (e.g., looking up in a table, a database oranother data structure), ascertaining and the like. Also, “determining”can include receiving (e.g., receiving information), accessing (e.g.,accessing data in a memory) and the like. Also, “determining” caninclude resolving, selecting, choosing, establishing and the like.

The phrase “based on” does not mean “based only on,” unless expresslyspecified otherwise. In other words, the phrase “based on” describesboth “based only on” and “based at least on.”

The previous description of the disclosed implementations is provided toenable any person skilled in the art to make or use the presentinvention. Various modifications to these implementations will bereadily apparent to those skilled in the art, and the generic principlesdefined herein may be applied to other implementations without departingfrom the scope of the invention. For example, it will be appreciatedthat one of ordinary skill in the art will be able to employ a numbercorresponding alternative and equivalent structural details, such asequivalent ways of fastening, mounting, coupling, or engaging toolcomponents, equivalent mechanisms for producing particular actuationmotions, and equivalent mechanisms for delivering electrical energy.Thus, the present invention is not intended to be limited to theimplementations shown herein but is to be accorded the widest scopeconsistent with the principles and novel features disclosed herein.

What is claimed is:
 1. A robotic medical system, comprising: a firstrobotic arm including a first instrument driver and a plurality ofrobotic joints, wherein the first instrument driver is configured tomanipulate a first tool that passes through a first cannula coupled tothe first robotic arm; and a second robotic arm including a secondinstrument driver and a plurality of robotic joints, wherein the secondinstrument driver is configured to manipulate a second tool that passesthrough a second cannula coupled to the second robotic arm, wherein thefirst tool is configured to rotate about a first remote center ofmotion; wherein the second tool is configured to rotate about a secondremote center of motion; and wherein a first remote center distancebetween the first robotic arm and the first remote center of motion isdifferent from a second remote center distance between the secondrobotic arm and the second remote center of motion.
 2. The system ofclaim 1, wherein: each of the first cannula and the second cannula isconfigured to intersect a body wall of a patient, the system is furtherconfigured to move each of the first robotic arm and the second roboticarm while maintaining each of the first remote center of motion and thesecond remote center of motion to reduce forces exerted on the bodywall.
 3. The system of claim 2, wherein: the first remote centerdistance is based on a distance between the first remote center ofmotion and an interface between the first robotic arm and the firstcannula, and the second remote center distance is based on a distancebetween the second remote center of motion and an interface between thesecond robotic arm and the second cannula.
 4. The system of claim 1,wherein the first cannula has a first length, and the second cannula hasa second length that is different from the first length.
 5. The systemof claim 1, further comprising: a processor; and at least onecomputer-readable memory in communication with the processor and havingstored thereon computer-executable instructions to cause the processorto: maintain the first remote center distance to be different from thesecond remote center distance.
 6. The system of claim 5, wherein thecomputer-executable instructions further cause the processor to adjustone or more of the first remote center distance and the second remotecenter distance.
 7. The system of claim 5, wherein thecomputer-executable instructions further cause the processor to adjustone or more of the first remote center distance and the second remotecenter distance to provide a null-space degree of freedom (DoF).
 8. Thesystem of claim 5, wherein: the computer-executable instructions furthercause the processor to adjust the first remote center distance toincrease a maximum distance the first tool is able to be inserted intothe patient.
 9. The system of claim 1, wherein the coupling of the firstrobotic arm to the first cannula comprises a mechanical coupling in theform of a latch.
 10. The system of claim 1, wherein the second roboticarm is uncoupled from the second cannula.
 11. The system of claim 1,further comprising: a processor; and at least one computer-readablememory in communication with the processor and having stored thereoncomputer-executable instructions to cause the processor to: determinethat movement of one or more of the first robotic arm and the secondrobotic arm are within a threshold distance of a collision, and adjustone or more of the first remote center distance and the second remotecenter distance to reduce the likelihood of the collision.
 12. Thesystem of claim 1, wherein: the system is further configured to adjustthe first remote center distance based on a force applied to the firstrobotic arm when in the remote center adjustment mode.
 13. A surgicalmethod, comprising: maintaining a first remote center distance betweenan interface between a first robotic arm and a first cannula coupled tothe first robotic arm, and a first remote center of motion, wherein thefirst robotic arm is configured to insert a first medical tool throughthe first cannula, wherein the first robotic arm is coupled to the firstcannula; and maintaining a second remote center distance between aninterface between a second robotic arm and a second cannula coupled tothe second robotic arm, wherein the second robotic arm is configured toinsert a second medical tool through the second cannula, wherein thesecond robotic arm is coupled to the second cannula; wherein the firstremote center distance is different from the second remote centerdistance.
 14. The method of claim 13, wherein the first cannula has afirst length, and the second cannula has a second length that isdifferent from the first length.
 15. The method of claim 13, furthercomprising: adjusting one or more of the first remote center distanceand the second remote center distance.
 16. The method of claim 13,further comprising: adjusting the first remote center distance toincrease a maximum distance the first medical tool is able to beinserted into the patient.
 17. The method of claim 13, furthercomprising: coupling the first robotic arm to the first cannula.
 18. Themethod of claim 13, further comprising: determining that movement of oneor more of the first robotic arm and the second robotic arm wouldposition the first robotic arm and the second robotic arm within athreshold distance of a collision; and adjusting one or more of thefirst remote center distance and the second remote center distance toincrease a distance of separation between the first robotic arm and thesecond robotic arm.
 19. A robotic medical system, comprising: a roboticarm including an instrument drive mechanism, the robotic arm associatedwith a cannula; a processor; and at least one computer-readable memoryin communication with the processor and having stored thereoncomputer-executable instructions to cause the processor to: adjust aremote center distance between the robotic arm and a remote center ofmotion.
 20. The system of claim 19, wherein the robotic arm is uncoupledfrom the cannula.
 21. The system of claim 19, wherein thecomputer-executable instructions further cause the processor to adjustthe remote center distance to provide a null-space degree-of-freedom(DoF).
 22. The system of claim 19, wherein: the cannula is configured tointersect a body wall of a patient, the cannula is associated with aremote center of motion, and the processor is further configured tocontrol movement of the robotic arm while maintaining the remote centerof motion.
 23. The system of claim 19, wherein the computer-executableinstructions further cause the processor to adjust the remote centerdistance to provide a null-space degree-of-freedom (DoF).
 24. The systemof claim 19, wherein: the robotic arm is configured to insert a medicaltool into a patient via the cannula, and the computer-executableinstructions further cause the processor to adjust the remote centerdistance to increase a maximum distance the medical tool is able to beinserted into the patient.
 25. A surgical method, comprising: providinga robotic arm comprising a drive mechanism, wherein the robotic arm isassociated with a cannula and a remote center of motion, the robotic armand the remote center of motion having a remote center distance therebetween; and adjusting the remote center distance between the roboticarm and the remote center of motion.
 26. The method of claim 25, furthercomprising: adjusting the remote center distance to provide a null-spacedegree-of-freedom (DoF).
 27. The method of claim 25, wherein the cannulais configured to intersect a body wall of a patient, the cannula beingassociated with the remote center of motion, the method furthercomprising: moving the robotic arm while maintaining the remote centerof motion with respect to the body wall.
 28. The method of claim 25,further comprising: adjusting the remote center distance to provide anull-space degree-of-freedom (DoF).
 29. The method of claim 25, furthercomprising: inserting a medical tool into a patient via the cannulausing the robotic arm; and adjusting the remote center distance toincrease a maximum distance the medical tool is able to be inserted intothe patient.
 30. The method of claim 25, wherein adjusting the remotecenter distance is further based on a force applied to the first roboticarm.